Pathophysiology Chapter 33 Disorders of renal function

A client has been given the diagnosis of diffuse glomerulonephritis. The client asks the nurse what diffuse means. The nurse responds:

"All glomeruli and all parts of the glomeruli are involved." Explanation: Glomerular changes can be diffuse, involving all glomeruli and all parts of the glomeruli; focal, meaning only some of the glomeruli are affected; segmental, involving only a certain segment of each glomerulus; and mesangial, affecting only mesangial cells. p882

The nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from which disorder?

Autosomal recessive polycystic kidney disease (ARPKD) Explanation: The typical infant with ARPKD presents with bilateral flank masses accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension. p865

Which statement about the use of angiotensin-converting enzyme (ACE) inhibitors and autosomal recessive polycystic kidney disease (ARPKD) is accurate?

ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction. Explanation: In addition to increasing water intake to decrease vasopressin levels, the angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) may be used to interrupt the renin-angiotensin-aldosterone system as a means of reducing intraglomerular pressure and renal vasoconstriction. Although not approved by the Food and Drug Administration (FDA), there has been recent interest in the use of vasopressin receptor antagonists (vaptans) to decrease cyst development. p882

A 34-year-old woman presents with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in her lower back. She is also experiencing dysuria, urinary frequency, and a feeling of urgency. Her partner states that she has been very tired the last few days and that she looked like she may have the flu. What is the most likely diagnosis?

Acute pyelonephritis Explanation: Acute pyelonephritis tends to present with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in the loin area of the back that is unilateral or bilateral. Lower urinary tract symptoms, including dysuria, frequency, and urgency also are common. There may be significant malaise, and the person usually looks and feels ill. Nausea and vomiting may occur along with abdominal pain. Cancer, kidney stones, and acute renal failure have different presentations. P871

Which clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)?

Bilateral flank masses and impaired lung development Explanation: Clinical manifestations of the typical infant with ARPKD include bilateral flank masses, accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension. Potter facies and other defects associated with oligohydramnios may be present. Hypertension is usually noted within the first few weeks of life and is often severe. p863

Which disorder of renal function primarily affects the proximal and distal tubules?

Chronic pyelonephritis Explanation: Pyelonephritis is an infection of the renal tubular structures, whereas nephritic disease involves the glomeruli. Polycystic kidney disease does not primarily afflict the tubules. Renal calculi have an obstructive etiology. p884

Which additional physical finding would you anticipate seeing in a child suspected of having a Wilms tumor?

Congenital anomalies, usually of the genitourinary system Explanation: An important feature of Wilms tumor is its association with other congenital anomalies, aniridia (absence of the iris), hemihypertrophy (enlargement of one side of the face or body), and other congenital anomalies, usually of the genitourinary system. Wilms tumor usually is a solitary mass that occurs in any part of the kidney. The common presenting signs are a large, asymptomatic abdominal mass and hypertension. p886

A young child has been diagnosed with Wilms tumor after the parent discovered an unusual mass, prompting a diagnostic workup. Which tumor characteristic is typical of Wilms tumor?

Encapsulated Explanation: Wilms tumor usually is a solitary mass that occurs in any part of the kidney. It usually is sharply demarcated and variably encapsulated. It is not a self-limiting health problem, and chemotherapy, radiotherapy, and/or surgery may be utilized. Symptoms include hypertension, abdominal pain, and vomiting. p886

Which assessment finding would lead the nurse to suspect the client has developed nephrotic syndrome?

Proteinuria and generalized edema Explanation: The nephrotic syndrome is characterized by massive proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized edema, and hyperlipidemia. Hematuria and anemia may be associated with a cancer. Renal colic is characteristic of kidney stones. Increased creatinine may be associated with systemic lupus erythematosus. p879

Which of the following clients is at greatest risk for developing a urinary tract infection (UTI)?

Older adult female client admitted with an indwelling Foley catheter that has been in place for 1 month Explanation: Urinary catheters are a source of urethral irritation and provide a means for entry of microorganisms into the urinary tract. Catheter-associated bacteriuria remains the most frequent cause of Gram-negative septicemia in hospitalized clients. A catheter in place for 1 month places the client at greatest risk for a UTI. P872

Which substance would not be found in glomerular filtrate?

Protein Explanation: The glomerular filtrate has a chemical composition similar to plasma (which contains sodium, potassium and water), but it contains no proteins because large molecules do not readily cross the glomerular wall. p879

A client is being treated for calcium oxalate kidney stones. The nurse will include which intervention in the client's care? Select all that apply.

Straining urine Administering calcium carbonate Increasing fluid intake Explanation: Clients with calcium oxalate crystals have excess oxalate levels. Calcium salts such as calcium carbonate bind oxalate in the intestine and decrease its absorption. Thiazide diuretics, not loop diuretics, are used to lower urinary calcium. Loop diuretics increase the amount of calcium in urine. The nurse should strain the client's urine to identify stones that are passed and encourage increased fluid intake to promote the dilution of urine. Daily weights are not needed for the client with renal calculi. p869

A young woman presents with signs and symptoms of urinary tract infection (UTI). The nurse notes that this is the fifth UTI in as many months. What would this information lead the nurse to believe?

There is possible obstruction in the urinary tract. Explanation: Urinary tract obstruction encourages the growth of microorganisms and should be suspected in persons with recurrent UTIs. The other answers can cause lower UTIs, but an obstruction would be considered because of the frequency of the infections. p866-867